Ask the Doctor
Questions from our Readers
By Dr. Barry A. Hendin
MSAA’s Chief Medical Officer
Q: I know that many people with MS are sensitive to heat, but I seem to be equally sensitive to the cold. Is this a symptom of MS, and can I be sensitive to both heat and cold?
A: Many people with multiple sclerosis are sensitive to heat, but as you are experiencing, a significant number of people with MS also have increased symptoms when feeling cold. The type of symptoms associated with sensitivity to cold, however, are often different than those experienced with sensitivity to heat.
Cold temperatures may increase spasticity and pain, and interfere with gait as well. Heat can slow down conduction in the central nervous system, and this can create a pseudoexacerbation in which old symptoms, such as visual blurring, numbness, or weakness, are transient and temporarily increased. Fortunately, these symptoms are short-term, without long-lasting effects.
Also, fortunately, we have several strategies for people with MS who experience temperature-related symptoms. For instance, when hot, people may wear cooling apparel, take a cool shower, and drink cool (non-alcoholic) beverages… and when cold, people can bundle up in additional layers, take a warm bath, and drink warm (non-alcoholic) beverages. Similar to so many MS symptoms, sensitivity to heat or to cold may not always be avoidable, but it is manageable.
Q: How often is plasma exchange used to treat MS relapses and what does the procedure involve?
A: This process of obtaining plasma is called “plasmapheresis,” and when the plasma is returned to the patient at the same time, this is referred to as “plasma exchange,” or “PE.” This treatment involves the separation of a patient’s plasma from their blood cells and then the reintroduction of the blood cells with stored or artificial plasma. The hope is to remove harmful antibodies and inflammatory proteins from the plasma.
PE is generally reserved for severe multiple sclerosis attacks (or relapses) that are unresponsive to steroids. It’s also a treatment of choice in neuromyelitis optica (NMO), which is a neurological condition that often presents similarly to MS (including optic nerve and spinal cord inflammation), but differs in how it affects nerve cells within the brain. In addition, its attacks are often more severe than those found in MS.
Although PE is generally a safe procedure, there are potential risks, including infection and blood clots. The risk of these adverse events is low, but they can occur in some individuals. The side effect profile is usually modest, but can include fatigue and low blood pressure. Affecting less than a third of patients, this drop in blood pressure can cause light-headedness, and in some cases, fainting, particularly in people with pre-existing heart conditions.
Q: Are individuals with MS at an increased risk of developing other autoimmune conditions, such as lupus, rheumatoid arthritis, or Guillain-Barré syndrome, as compared to those without MS?
A: Although many neurologists were taught that there was an increase in other autoimmune conditions in MS, the results of multiple studies regarding autoimmunity in MS have been inconsistent. This is in contrast to neuromyelitis optica (NMO), which is clearly associated with a multitude of other autoimmune conditions.
The most clearly documented autoimmune conditions with multiple sclerosis at this time appear to be autoimmune thyroid disease, psoriasis, and inflammatory bowel disease. Please note, however, that this answer may change in the future as more studies are conducted.